Maintenance of a patent airway is a fundamental responsibility of the anesthesiologist. Tracheal intubation remains one of the commonest means of establishing an airway. Placing the head and neck in the sniffing position has traditionally been considered important for obtaining good glottic visualization during direct laryngoscopy. Direct laryngoscopy is used to facilitate tracheal intubation under vision. Successful direct laryngoscopy depends on achieving a line of sight from the maxillary teeth to the larynx ¹.It has been clearly established in several studies that proper positioning of head and neck is one of the most important step towards laryngoscopy and tracheal intubation which helps in obtaining a good glottic view, thus minimizing the rate of tracheal injury, duration of the procedure, repeated attempts at laryngoscopy and intubation- ultimately reducing the overall rate of trauma and further complications. Best laryngoscopic views are obtained when oropharyngo-laryngeal axes come in a straight line. The ‘sniff’ position has been advocated as a standard for direct laryngoscopy. In this position, the neck is flexed on the chest and the head is extended on the atlanto-occipital joint by elevating the head on a pillows ^2,3.The ‘sniff’ position is usually the best starting position for direct laryngoscopy. In the ‘sniff’ position, the cervical spine below C5 is relatively straight, there is increasing flexion from C4 to C2, and the head is fully extended (occipito– atlanto–axial complex) ⁴. Neck flexion between C2 and C4 is achieved by elevation of the head.

Operating table height can influence task performance and physical/mental workload^{5, 6} .There have been few studies of the correlation between the operating table height and the quality of laryngeal view during direct laryngoscopic (DL) intubation⁷. In an editorial on anesthesiologist stature and patient positioning, Heath⁷ highlighted the benefits of using an adjustable operating table and the ergonomic benefits of different heights—high during cannulation to prevent back discomfort, a bit lower for airway management, and even lower for short trainees. It has been suggested that the patient’s face should be placed at the height of the anesthesiologist’s xiphoid process for comfortable intubation without requiring the anesthesiologist to bend his/her back ^8-10 and that the physician’s eyes should be placed 1 foot (30 cm) above the patient’s face to provide proper angles and distances for laryngoscopy ¹¹. However, these results are based on clinical experience rather than scientific validation.